title: Pharyngo-occipital artery variant arising proximal to occluded internal carotid artery: the risk of an unnecessary endarterectomy.
abstract: Collateral branches originating from the cervical internal carotid artery (ICA) are rare but can have significant clinical and surgical implications. We present a case of pharyngo-occipital artery arising proximal from an occluded ICA that was missed and confused for severe stenosis of the ICA, leading to the misguided indication for carotid endarterectomy. Advanced preoperative studies allowed timely recognition of this anomaly and reconsideration of the therapeutic plan. We stress the importance of recognizing these variants by careful examination of multimodal pre-surgical exams. Awareness of these variants will allow a more precise diagnosis, and more appropriate management of patients with carotid artery disease.
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel; Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: jcohenns@yahoo.com.
authors.forename: José E
authors.initials: JE
authors.lastname: Cohen
authors.affiliation: Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Ronen R
authors.initials: RR
authors.lastname: Leker
authors.affiliation: Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Moshe Gomori
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem 91120, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Itshayek
mesh_terms: D015901:Angiography, Digital Subtraction; D002343:Carotid Artery, Internal / Q000002:abnormalities* / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000601:surgery; D003097:Collateral Circulation; D016894:Endarterectomy, Carotid; D006801:Humans; D008297:Male; D008875:Middle Aged
keywords: Anatomic variant; Carotid endarterectomy; Carotid stenosis; Occipital artery; Stent; Stroke